Provider Demographics
NPI:1366656845
Name:EASTER SEALS SOUTHERN COLORADO
Entity Type:Organization
Organization Name:EASTER SEALS SOUTHERN COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-574-9002
Mailing Address - Street 1:225 S ACADEMY BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-2768
Mailing Address - Country:US
Mailing Address - Phone:719-574-9002
Mailing Address - Fax:719-574-1330
Practice Address - Street 1:225 S ACADEMY BLVD STE 104
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-2768
Practice Address - Country:US
Practice Address - Phone:719-574-9002
Practice Address - Fax:719-574-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service